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The No-Brainer Case for Universal Long-Term Care

The author of this article makes a strong argument for a universal, social insurance model of Long Term care for the nations growing populations of older citizens.

Progressives have increasingly coalesced around a single-payer Medicare-for-All system as the goal for American healthcare. There is one piece of our healthcare system in particular where single-payer is the undeniably obvious solution: long-term care.

Long-term care encompasses everything from nursing homes to home health aides to rehabilitation for injuries or disabilities. It includes all forms of care that people need when they can no longer care for themselves due to old age, chronic illness, or disability. Thirteen million people in the United States require long-term care. About 60 percent are seniors; the rest are younger people with disabilities.

Long-term care is extremely expensive. The United States spends upward of $330 billion each year on long-term care, accounting for around 14 percent of total national healthcare expenses. The median cost of staying in a nursing home is over $90,000 per year. A home health aide typically costs at least $45,000 each year.

Our current system for paying for long-term care is deeply inadequate. While Medicare funds most other healthcare costs for seniors, it does not cover long-term care (except for short stints following hospitalization). The primary public payer for long-term care services is Medicaid, which covers over 50 percent of all long-term care costs. But like the rest of Medicaid, this benefit is means-tested for people without disabilities, and only pays for long-term care for people whose assets and income fall below a certain threshold (the exact dollar amounts vary state by state).